Christopher Kirk-Ryan Phillips, D.D.S

Primary specialty

DentistTaxonomy code 122300000X

License

11793 Issued in TN

Practice address

801 W Main St Ste B
Woodbury, TN 37190-1048

Phone

(615) 563-2266

NPI assigned

Jul 22, 2021

Last updated

Apr 28, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Chokka Dental Corporation

  dba Imperial Dental Practice

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Yucaipa, CA
  • NPI 1639270234
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1626912000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651104000000",
    "number": "1205409554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1576 BIRCHWOOD CIR",
            "city": "FRANKLIN",
            "state": "TN",
            "postal_code": "370646871",
            "telephone_number": "909-856-2011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 W MAIN ST STE B",
            "city": "WOODBURY",
            "state": "TN",
            "postal_code": "371901048",
            "telephone_number": "615-563-2266"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "34880 Yucaipa Blvd",
            "address_purpose": "LOCATION",
            "city": "Yucaipa",
            "state": "CA",
            "postal_code": "923994235",
            "country_code": "US",
            "telephone_number": "909-797-1136",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PHILLIPS",
        "first_name": "CHRISTOPHER",
        "middle_name": "KIRK-RYAN",
        "credential": "D.D.S",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-07-22",
        "last_updated": "2022-04-28",
        "certification_date": "2022-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "106591",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TN",
            "license": "11793",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "CPS",
            "affiliation": "N",
            "address_1": "34880 Yucaipa Blvd",
            "city": "Yucaipa",
            "state": "CA",
            "country_code": "US",
            "postal_code": "923994235",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Ocoee Foundation-CC LLC (Woodbury Nursing and Rehabilitation Center)
• Suzanne Lavene Parsley, RN
• Cara M Peffley, LMT
• Natalie G Perkins, M.S., CCC-SLP
• Paul Vincent Petrilli, CRNA
• Holly Rae Phipps
• Pmi Diagnostics
• Barbara Ann Prater
• Ashley Nicole Reed, RN
• Results-Ast JV, LLC

• Dentist in Woodbury, TN
• Providers in Woodbury, TN by specialty
• Dentist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.